Giant hydronephrosis: A rare cause of secondary hypertension

Abstract

Background: Hypertension secondary to giant hydronephrosis (GH) is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback. In adults, GH is often diagnosed late due to nonspecific abdominal symptoms that may not manifest until advanced stages. Early identification is crucial, as failure to diagnose can lead to significant complications.

Case Presentation: A 60-year-old hypertensive female presented with vague right-sided abdominal pain for two weeks. Contrast enhanced computed tomography of abdomen and pelvis revealed a grossly hydronephrotic right kidney with severe pelvicaliectasis crossing the midline with thinned out parenchyma, due to ureteropelvic junction obstruction (UPJO). A renogram confirmed a non-functioning right kidney. She underwent right nephrectomy, during which 2.5 L of hemorrhagic fluid were drained. Histopathology confirmed hydronephrosis with chronic pyelonephritis. Postoperatively, her hypertension resolved, and antihypertensive medication was discontinued. At 1- and 3-month follow-ups, her blood pressure remained stable, underscoring the connection between GH and secondary hypertension.

Conclusion: GH in adults is a rare but treatable cause of secondary hypertension. Clinicians should consider renal imaging for patients presenting with unexplained hypertension to rule out hydronephrosis, ensuring timely diagnosis and management.

Keywords

giant hydronephrosis / non-functioning kidney / renin-angiotension-aldosterone system / secondary hypertension / tubuloglomerular feedback / UPJ obstruction

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